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POSTED ON KROLL MAP NO.: PERbII T
BUILDING DEPARTMENT Applicant FW
MBER 0338
NU 68
PERMIT APPLICATION inside Heavy Lines
JOB ADDRESS
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BUOINEBS)
NAME (OR NAME OF
SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK
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MAILING ADDREUB
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--VACANT BITE
USE ZONE LOT AREA
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V/ 10 02 R.
CITY
S97�1_77_49_
STATE LICENSE NUM13ER
.;7. a 3 ao / L3 c?,:2
Legal D 1ption of Property (Show Bt
-Le73 k)6Ef-z
10 -:- I) ) A -4- 4- ,
W
01000110110
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TELEPHONE 141
rl�l JI/ 91
crrx LICENSE
v or Attach Four
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FA
NEW
RESIDENTIAL
F -1
GAS
LINE
NON-RESIDENTIAL
I
SIGN
AnD
RETAINING
DEMOLISH
WALL
ALTER
EXCAVATE
OR FILL
FENCE
( x Ft.)
.......... ..........
REPAIR
PRE -MOVE
INSP.
El
swim
POOL
'IUMBEH OF STORIES
I NUMBER OF
DWELLING
UNITS
il
X 50
.OT PLAN (Indicate BUIRIJ1194ett)MCIER, abutting
,77 /Ii�
t
N
I
I hereby acknowledge that I have read this application; that the In-
formation given In correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state lawn regu-
lating construction; and in doing the work authori,-,ed thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Umit One Year (Except DEMOLITIONS which
bball be completed In ninety days; INIOVED-IN BUILDINGS shall be com-
pleted In nix months.)
FIG —NATURE (OWNER OR AGE T) DATE SIGNED
71-) -4
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property UNIA.
Any construction on the public domain (curbs. sidewalks, driveways,
marqu"g, etc.) will require separate permission.
YES
REIGHT
BUILDING
AREA
VARIANCE NUMBER
PLOT PLAN APPROVED
STREET R/W
EXISTING STREET R/W ............ FT.
DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT.
............ ITT.
0
REMARKS
CHECKED BY
METER SIZE I 13ERVICE SIZE I CLEARANCE ICHECKED BY
REMARKS
[3 YES
VERIFIED BY
PERMIT NUMBER Cd
TYPE OF CONSTRUCTION 13TREET IMPROVED
YES
DDCTOR REQUffiED-1 OCCUPANCY GROUP
&VO
F) BY
rian Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORIE NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
Valuation
Fee
M
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
FILE
. M
RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
'u .. L""
(Rough)
C'LVOLf,
%'T Frame
Furnace & Fuel Line,--,,.
-e
Final 911��
RECORD OF INSPECTIONS
Date Passed
Drainage
Sewer
Parking
Landscaping
Fire Dept.